Overview

Although there are a variety of core programs to choose from in the CARF standards manual, outpatient treatment is the most common form of service delivery for opioid substitution treatment (methadone maintenance) in the United States.

Outpatient programs provide services that are typically delivered in a clinic setting and may include offerings such as individual counseling, group therapy, psychoeducation, and family counseling. Intensive outpatient opioid treatment programs (OTPs) are distinct in that they have a scheduled series of individual, family, group and/or psychoeducational opportunities for a total of at least nine direct contact hours per week, that can be provided during the day, evening or on weekends.

Accreditation Requirement(s)

To conform to these standards, the organization must show evidence of the following:

For Outpatient:

• All outpatient programs should be able to provide individual, family and group counseling or therapy, along with psychoeducation.
• Services should be provided in locations/settings that meet the needs of clients.
• Outpatient treatment services should be coordinated with other providers (with permission of the client).
• Treatment interventions that are utilized are recognized (research or evidence-based) in the addictions field.
• Medical record documentation on treatment interventions is ongoing.

For Intensive Outpatient:

• At least 9 direct contact hours of service (in any combination) are provided weekly.
• Services are offered at a time that is convenient to clients and/or family members.
• A qualified behavioral health practitioner determines the level of care appropriate for these services.
• At least monthly, the individual plan (treatment plan) is reviewed and modified, as necessary.

Implementation Tips

Some Implementation Tips provided, in part, by Robert Johnson at: www.accreditationnow.com.

• The organization's Written Program Plan should describe the type of programs and services being offered.
  
  
• From the comprehensive assessment of the individual, conducted by a qualified behavioral health practitioner (as determined by the program's policies or state regulations), the appropriate level of care is determined to best assist the client in his or her recovery, whether that is outpatient or intensive outpatient, detoxification, residential treatment, and therapeutic community. Use of the American Society of Addiction Medicine's criteria (The Patient Placement Criteria for the Treatment of Psychoactive Substance Use Disorders, 1991) is helpful to determine the best level of care.
  
  
• Types of services offered in outpatient include individual counseling/therapy, group counseling/therapy, specialized group counseling on topics such as cocaine use, HIV/AIDS, relapse prevention, women's and men's identification issues, nutrition, dual diagnosis, family issues, building self-esteem, parenting, medication effects, stress management, and/or psychoeducation on these topics. In addition, family counseling/therapy should be offered. Family counseling might take the form of family therapy in an individual or group setting and/or there might be a "family night" offered, or informal family gatherings to provide support and education.
  
  
• If psychotherapy, as opposed to counseling, is being provided in any form, then clinicians on staff should have the specialized knowledge, skills and abilities to provide such services.
  
  
• Other interventions that could be offered in an outpatient setting include acupuncture, contingency contracting, vocational counseling, smoking cessation, exercise, HIV pre and post-test counseling, and support groups.
  
  
• An intensive outpatient program is typically composed of a combination of individual counseling (one hour per week), group counseling (3 times per week for 2 hours) and psychoeducation/family activities (for 2 hours per week). CARF does not prescribe the specific content/times, except for requiring at least a total of 9 hours of service per week.
  
  
• An excellent resource for describing services and evaluating an outpatient or intensive outpatient program is the newly released the Substance Abuse and Mental Health Services Administration's (SAMHSA) TIP #20, Matching Treatment to Patient Needs in Opioid Substitution Therapy and Tip #43, Medication Assisted Treatment for Opioid Addiction in Opioid Treatment Programs.